초음파 파쇄법을 이용한 내고정물 주위 감염 진단의 효용성 = Usefulness of Sonication in Implant-Related Infection

다국어 초록 (Multilingual Abstract)

Purpose: This study determined whether the sonication of explants could improve the detection of bacteria and influence the optimal antibiotics treatment.
Materials and Methods: This retrospective study included the patients who underwent implant removal surgery followed by sonication culture as well as tissue culture in order to diagnose implant-related infection. A total of 37 consecutive patients with 41 cases were included. The patients’ demographic data, use of preoperative antibiotics, type of implants, change of antibiotics following the culture results, and recurrence of infection were all reviewed.
Results: Among 41 cases, 20 cases met the diagnostic requirements for implant-related infection as defined by musculoskeletal infection society criteria, while the other 21 cases had explant sonication to exclude indolent infection or residual infection. The latter showed negative results on the both explant cultures and tissue cultures. Among the 20 cases that met the requirements for implant-related infection, 19 cases (95.0%) were identified by any cultures. Of the 19 cases with positive culture results, 2 cases (10.5%) showed positive results only on sonication cultures, and one case (5.3%) showed positive results only on tissue culture. In 1 case of culture negative implant-related infection, a drain sinus was present preoperatively, but the cultures were negative according to both methods. The culture results made postoperative antibiotics change in 12 cases among the 19 culture (+) cases. Antibiotics changes were based on the tissue culture in 2 cases, 2 cases were based on the sonication culture, and the remaining 8 cases were based on both cultures.
Conclusion: The sonication culture improved the diagnosis of implant-related infection combined with conventional tissue culture and helped to determine administering the proper antibiotics.

국문 초록 (Abstract)

목적: 내고정물 주위의 감염에서 내고정물 제거물의 초음파파쇄법을 이용한 미생물 배양 검사가 배양률, 진단율을 높일수 있는지, 그리고 항생제 선택에 영향을 줄 수 있는지 확인하고자 시행되었다.
대상 및 방법: 내고정물 주위 감염의 진단 혹은 배제를 위해내고정물 제거를 시행하면서 초음파 파쇄법을 이용한 배양검사 및 일반 조직 배양 검사를 시행했던 37명 환자의 41예수술을 후향적으로 분석하였다. 수술 전후 사용한 항생제의종류 및 기간, 금속물의 종류, 배양 검사 결과와 그에 따른 항생제 변경 유무, 감염의 재발 유무를 확인하였다.
결과: 41예의 내고정물 제거술 중 수술 전 감염이 의심되어 배양 검사를 시행한 경우는 20예였고, 이들은 모두 감염으로진단되었다. 임상적으로 수술 전 감염이 의심되지는 않았으나 잠재적인 감염의 배제를 위해 배양 검사가 시행된 21예에서는 모두 배양 검사 음성이 확인되었다. 감염으로 진단된 20 예 중 두 검사 중 하나라도 양성을 보인 경우는 95.0%였다.
배양 검사 양성이었던 19예 중 금속물 초음파 파쇄법에서만양성을 보인 경우는 2예였다. 금속 배양 검사가 음성이면서일반 조직 배양 검사가 양성인 경우는 1예였다. 배양 검사 음성 감염자 1예에서는 술 전 배농동이 있었으나 두 배양 검사모두에서 음성이었다. 배양 검사 양성 내고정물 주위 감염 19 예 중 12예에서 배양 검사 결과 이후 항생제 변경이 있었고, 그 중 2예는 일반 조직 배양 검사를 근거로, 2예는 금속물 배양 검사를 근거로, 8예는 두 검사 모두를 근거로 하였다.
결론: 내고정물 초음파 파쇄법을 이용한 금속 배양 검사는 일반 미생물 배양 검사와 함께 시행될 때 내고정물 주위 감염의진단율과 미생물 배양률을 높일 수 있었고, 항생제 결정에 도움을 주었다.

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